In June 2014, the Government of India (GOI) published the policy guidelines, Use of Antenatal Corticosteroids in Preterm Labour, (Under Specific Conditions by Auxiliary Nurse Midwives), Operational Guidelines. With the release of this policy the Ministry of Health and Family Welfare (MOHFW)/ GOI is rolling out antenatal corticosteroids (ACS) including support for auxiliary nurse midwives (ANMs) to administer a pre-referral dose of ACS to pregnant women in preterm labor at public health facilities.
Both the India Newborn Action Plan (INAP), and the WHO Recommendations on Interventions to Improve Preterm Birth Outcomes acknowledge the benefit of ACS. However, the WHO recommendations only recommend ACS for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met:
- Gestational age assessment can be accurately undertaken;
- Preterm birth is considered imminent (within 7 days);
- There is no clinical evidence of maternal infection;
- Adequate childbirth care is available (including the core functions of emergency obstetric care); and
- The preterm newborn can receive adequate care if needed (including resuscitation, thermal care, feeding support, infection treatment and safe oxygen use).
To inform the national ACS policy and evaluate the implementation of the new policy, the MOHFW requested Every Preemie to assess the current implementation of ACS in two districts – Hasar and Ambala – in Haryana State.
The assessment included three phases of engagement:
Phase 1: Assess current availability and use of ACS in selected sites in Haryana State, and compliance with the MOHFW Use of Antenatal Corticosteroids in Preterm Labour Operational Guidelines (Under Specific Conditions by Auxiliary Nurse Midwives), and identify critical pre-conditions needed to safely administer pre-referral first dose ACS within the primary health care unit setting.
Phase 2: Disseminate the findings of the assessment and work with GOI stakeholders to review current implementation practices vis a vis the GOI policy for ACS use, and update the national operational guidelines/policy for the use of ACS to align with the Phase 1 study findings, the latest available evidence and the WHO Recommendations on interventions to improve preterm birth outcomes, 2015.
Phase 3: Evaluate, in the same sites within Haryana State, the implementation of standard practice of the revised operational guidelines for ACS administration in facilities that meet the health system preconditions. Disseminate findings from this assessment and work with GOI stakeholders to make additional changes to the revised national guidelines as needed.
The project worked with the Post Graduate Institute of Medical Education and Research (PGIMER) as the local research partner, and established a Project Advisory Group in collaboration with the GOI to work with the study team to review and revise the policy guidelines. The final revised guidelines have been submitted to the GOI.
Two manuscripts on this research are underway. One focuses on maternal health and women’s experience receiving ACS, and the second examines health system readiness to deliver ACS. Once published, links to the articles will be added to this page.